Register

Please fill in the form below to register your account. Once you have registered, you will be able to manage your account by keeping your information updated.

If you have registered for an account, please login.

User Information

Email Address *

First Name *

Last Name *

Contact Number *

Username

Company name (optional)

User Password *

Confirm Password *

LRON Information

Are you a LRON member? *

Vehicle Type *

Medical Aid Information

Medical Aid Name *

Medical Aid Number *

Medical Aid Main Member *

Are you on chronical medication? Please specify? (optional)

Do you have any allergies? (optional)

Home Doctor

Home Doctor Contact Number

Next of Kin

Name and Surname *

Relationship *

Contact Number *

Kindly upload a copy of your Medical Aid Card

Drop your file here or click here to upload You can upload up to 5 files

Declaration *I hereby confirm that I am in general good health and are fit to partake in the Land Rover Events.

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